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Human Resources

Prescription Drugs Benefits

All of the state of Iowa's health plans provide prescription drug coverage. Following is a brief summary of the prescription drug benefits for the state of Iowa's health insurance plans.

Deductible 3 Plus
Program 3 Plus
Iowa Select PPO
Blue Access
Blue Advantage
Side-by-Side Comparison

Additional Information and Resources

Vaccines at the Pharmacy , Specialty Drugs and General Prescription Drug Information can be found at the DAS Wellness Prescription Drugs Web site.

Deductible 3 Plus Plan

Your prescription drug benefits are covered on a “cash and carry basis.” This means that you pay the full cost of the prescription and are reimbursed for 80% of Wellmark’s allowed amount after you meet your deductible. If you use a participating pharmacist, the pharmacist will file the claim for you, which will result in lower out-of-pocket costs, and a quicker turnaround for reimbursement. If you do not go to a participating pharmacy, you will have to submit a paper claim to Wellmark and will be reimbursed at 80% after deductible of what Wellmark would have paid to a participating pharmacy.

Mail Order Prescription Drugs

A mail order prescription drug benefit is not available in the Deductible 3 Plus plan.

Out-of-Pocket Maximum

There is no separate prescription drug out-of-pocket for the Deductible 3 Plus plan. Prescription drugs copayments are applied to the medical out-of-pocket maximum - $600 (single)/$800 (family).

View the side-by-side comparison of the different health insurance prescription drug benefits.

Program 3 Plus and Iowa Select Plans

Your prescription drug benefits are provided through a three-tier program. This means that you pay a copayment at the time you receive your prescription until you reach your separate prescription drug out-of-pocket limit.

The amount of your copayment is determined by the drug that you receive. Copayment amounts are:

  • $5.00 for preferred generic drugs
  • $15.00 for preferred brand name drugs
  • $30.00 for non preferred brand name and non preferred generic drugs

If a generic equivalent is appropriate and available and you choose a brand name drug, you are responsible for the copayment plus any difference between the maximum allowable fees for the generic and brand name drug, even if the provider has specified that the brand name drug must be taken. You will be required to pay this difference even after you have reached your separate prescription out-of-pocket limit.

Mail Order Prescription Drugs

You can save money and have the convenience of home delivery if you use mail order for your maintenance prescription drugs. You can receive up to a 90 day supply for just two copays instead of three by using mail order

Out-of-Pocket Maximum

There is a $250 (single)/$500 (family) out-of-pocket maximum for prescription drugs. This out-of-pocket maximum is separate from the medical out of pocket maximum.

View the side-by-side comparison of the different health insurance prescription drug benefits.

Blue Access
Blue Advantage

Your prescription drug benefits are provided through a three-tier program. This means that you pay a copayment at the time you receive your prescription.

The amount of your copayment is determined by the drug that you receive. Copayment amounts are:

  • $5.00 for preferred generic drugs
  • $15.00 for preferred brand name drugs
  • $30.00 or 25% (whichever is higher) for non preferred brand name and non preferred generic drugs.

If you purchase a brand name drug when an FDA-approved generic equivalent is available, you are only responsible for the copay.

Mail Order Prescription Drugs

You can save money and have the convenience of home delivery if you use mail order for your maintenance prescription drugs. You can receive up to a 90 day supply for just two copays instead of three by using mail order

Out-of-Pocket Maximum

There is no separate prescription drug out-of-pocket. Prescription drug copayments do not apply to the medical out-of-pocket maximum.

Below is a side-by-side comparison of the different health insurance prescription drug benefits.

Side-by-Side Comparison of the Prescription Drugs Benefits

30-day Supply
 
Deductible 3 Plus
Program 3 Plus
Iowa Select
Blue Access
Blue Advantage
Preferred Generic
20% after deductible
$5.00
$5.00
Preferred Brand
$15.00
$15.00
Non-Preferred Brand
Non-Preferred Generic
$30.00
$30.00 or 25%*
whichever is higher

* For self-administered specialty drugs, the copay is $30. The coinsurance of 25% does not apply.

90-day Supply (Mail Order)
 
Deductible 3 Plus
Program 3 Plus
Iowa Select
Blue Access
Blue Advantage

Preferred Generic
Not Available
$10.00
$10.00
Preferred Brand
$30.00
$30.00
Non-Preferred Brand
Non-Preferred Generic
$60.00
$60.00

 

Site updated 12/15/2008


This Web site describes the benefits in effect on January 1, 2009. The site does not meet the requirements of a summary plan description and is not intended to serve as one. If there are discrepancies between this information and any of the plan documents or State of Iowa policies, the plan documents or State of Iowa policies will govern in all cases.